Indiana Code Title 25. Professions and Occupations § 25-1-9.8-18

Sec. 18. (a) Each provider must make diligent attempts to ensure that the patient is aware of the patient's right to request a good faith estimate under this chapter.  The communication by each provider of information to the patient concerning the right to a good faith estimate must be conspicuous and must be provided by at least three (3) of the following means:

(b) The communication required under subsection (a) must state the following, or words to the same effect:  “A patient may ask for an estimate of the amount the patient will be charged for a nonemergency medical service provided in our office.  The law requires that an estimate be provided within 2 business days of scheduling the nonemergency health care service unless the nonemergency health care service is scheduled to be performed by the practitioner within 2 business days of the date of the patient's request.”.